Individual
KENNETH JARED LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
204 N AUBURN AVE, FARMINGTON, NM 87401-8412
(505) 325-8401
(505) 325-8705
Mailing address
204 N AUBURN AVE, FARMINGTON, NM 87401-8412
(505) 325-8401
(505) 325-8705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1834
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
891069
UNITED CONCORDIA
NM
01
—
NM008392
BLUECROSS BLUESHIELD
NM
Enumeration date
07/30/2006
Last updated
07/08/2007
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